By Mark B. Bromberg, A. Gordon Smith
Offering a close learn of the anatomy, body structure, and pathology of peripheral nerves, this reference offers a transparent method of the overview, characterization, and therapy of peripheral neuropathies-reviewing every one significant type of those issues with authoritative discussions of medical features, electrodiagnostic positive aspects, exam findings, and healing procedures and results.
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Although the presence of positive waves and fibrillation potentials does not distinguish between neuropathic and myopathic causes, the clinical context usually should be sufficient to distinguish between the two conditions. Other needle EMG findings focus on the MUAP, and in neuropathic conditions findings include reduced MUAP recruitment, increased amplitude, and increased number of phases and turns. 2. Localization of Axonal Damage Nerve conduction studies are most suitable for the study of distal muscles, whereas needle EMG allows assessment of almost any muscle.
2. Signs The clinical neurologic examination is sensitive for peripheral nerve loss and dysfunction, and informative for localization. An appreciation of nerve physiology and pathology, and the limitations of clinical testing, are necessary to accurately interpret the clinical examination. It is important to emphasize that the sensory examination can be challenging and confusing because responses are indirect and represent a patient’s interpretation of the testing questions. Accordingly, it is important that the patient fully understands the object of the test.
Empiric data from the great toe indicate that young adults lose vibration perception after 15 s, with a loss of 1 s per decade of age, and a loss of vibratory perception in ,10 s is abnormal at any age (4). 3. Sharp Stimuli The goal is to apply a sharp stimulus without also applying undo pressure on the skin. ”. Inability to distinguish between sharp and dull supports loss of nociceptive fibers relative to low-threshold mechanoreceptor fibers. 4. Position Sense The ability to detect changes in digital joint position is normally exquisite (two degrees).
Handbook of Peripheral Neuropathy by Mark B. Bromberg, A. Gordon Smith